Preop Glycemic Control Decreases Infection Risk

Tight control of glucose in the postoperative period results in fewer complications, including infections, and decreased mortality in both diabetic and nondiabetic patients. Diabetic patients with good preoperative glycemic control had significantly fewer postoperative infections in a retrospective analysis of data from the Veterans Affairs National Surgical Quality Improvement Program.

The study included 490 diabetic surgery patients from the National Surgical Quality Improvement Program database, which prospectively collects preoperative, intraoperative, and 30-day outcomes on major noncardiac operations. All patients had a hemoglobin A1c (HbA1c) level recorded within 180 days prior to the surgery, with good glucose control defined as a level of less than 7%. The primary outcome of the study was postoperative infectious complications, including pneumonia, wound infection, urinary tract infection, and sepsis.

After adjusting for several factors known to be associated with postoperative infections, the researchers found that good long-term glycemic control was strongly associated with significantly fewer postoperative infections (odds ratio 2.13). Age, American Society of Anesthesiologists score, operation length, and wound class were also significantly associated with the risk of postoperative infection.

A highly significant finding of this study was the increased incidence of postoperative hyperglycemia in the poorly controlled group, compared with the well-controlled group (78% vs. 43%).

The reason for the current study’s finding of decreased postsurgical infection in association with good preoperative glycemic control could be linked simply to the better likelihood of postoperative glycemic control, as demonstrated by the another study, noted the authors. “Acute hyperglycemia has clearly been shown to be associated with poor outcome in a variety of clinical settings. … Tight control of glucose in the postoperative period results in fewer complications, including infections, and decreased mortality in both diabetic and nondiabetic patients,” they wrote.

Another possible explanation for their findings is simply “the overall improvement in general health and metabolic milieu of the well-controlled diabetic patient.”

Arch. Surg. 2006;141:375–80.

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